Scope of Real Time Fluorescence Imaging in Esophagectomy

Abstract

Esophagectomy is a challenging surgery that is known to be associated with high rates of morbidity. Anastomotic leaks, pneumonia, conduit necrosis and chyle leaks are the commonly reported complications. Perfusion assessment and tissue injection based fluorescence guided surgery (FGS) are the newer clinical applications of fluorescent dyes. With the advent and integration of real time fluorescence imaging with the existing minimal access platforms, the esophageal surgeon can employ these techniques to potentially improve outcomes. During thoracic dissection, thoracic duct lymphography, fluorescence guided airway visualization, tracheal perfusion assessment and sentinel lymph node biopsy/dissection are the reported clinical applications. In the abdominal dissection, gastroepiploic arcade identification, gastric conduit perfusion assessment and proximal esophagus perfusion assessment have been described. Using the different routes of administration, the same dye can be used for different uses at separate points in a single esophagectomy surgery. The principles and evidence pertaining to these applications have been outlined.